03080081 J
OF CUPEW11NOl.ranc orvlslon PERMIT CONTRACTRInDIyREss: MACKEY CONSTRUCTION PERMIT N0o3080081
021 RAXTRY CT
NAME: 2593 HEBRON AVE PERMIT ISSUE DATE
BA SATHYA 03
(408) 274-6799 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
100
LICENSED CONTRtook,
DECLARATION
wF I hcrtby affirm Iwl 1 am licensed under and
professions
chapter 9 hommense is Job Description
�iuy' with Section701of Division 3 of
Business end ProfcssinnsCode.and my license is
>>„ inrwm(eayJerrem.� a 51/{ p133 REMODEL (E) BATH T0 .2 BATHRMSFINALE®
jn? Liccnsc Cru4
r O / /” Contractor
rJ` AR ITE RATION
fw� . slant sun ,plans d Ii r modFEB 0 3 2004
of Lol Propassional 'T
S OWNER-BUILDER DECLARATION I,
BUILDING�'LD 'v
a y 1 hereby affirm that I am exempt from the Contractor's License Law for the - Ip� I{�1�
00 following reason.(Section 7031.5.Business and Professions Cade:Any city fir county B
<$ which requires a permit to ennalrua,alter,improve,demolish,or repair any structure
poor to its issuance.also requires the applicant for such permit to rile a signed statement
Eire thatheislicensed pursuan0othe pmu
visimnfthe Commct.CsLicense a.(Chaprer9 Sq.FL Floor Area Valuation
e�0 (Commencing with Section 711(10)of Division 3 of the B usimcm and Professions Code)or
9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of 35606022 . 00
Section 7011.5 by any applicant for a Permit subjects the applicant to a civil penally of APN Number Occupancy Type
not mom than five hundred dollars($50r,
P Y YP
❑1,az owner of the pmpsny,or my employees with wages az their sole compensation,
will do the work.and to,swcture is not intended or offered for sale(Sec.7064,Business —
and Professions Code:The Contractor's License Law does not apply to an owner or Inspections
Property who builds or improves thereon,and who does such work himself or through his 102 - PIERS
own employees.provided that uch improvements arc not intended or offered for sale.If. 103 — UFER
however,the building or impromment is sold within one year of completion.Ne owner-
builder will have the burden of proving mat he did not wild or improve for purpoee or 104 - REBAR
1c'l' 105 - ANCHOR BOLTS
❑I,as owner of the property,am exclusively contracting with licensed convectors to
Combed the pmject(Sec.7014,Business and Pronasions Code:)The Contractor's Li 106 — SEWER & WATER
cense Law does not apply Loan owner of pouleny who wilds or improves thereon.and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a convactor(s)licensed pursuant to ft Contractor's
License law. 203 - UNDERFLOOR MECHANICAL
❑I am exempt under Sec. ,B h P C for Nis rcazon 204 - UNDERFLOOR FRAME
Date205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
IherebyanrmunderPenalty ofpeduryone ofthe following declarations: 301 - ROUGH PLUMBING
l have and will maintain.Cenircale of consent to xlGinsure for Worrier's Compen. 302 — TUB & OR SHOWER
sation,as provided for by Section 3700 of the labor Code.for the performance of the 303 - ROUGH MECHANICAL
wink for and will
permit :issued. 304 - ROUGH ELECTRICAL
37 1 have and will maintain Worker's Compensation Insurance,az required by Section
neo or the Labor Coale.for the Performance or the work for wmrn this pem,n is issues. 305 - FRAME
My workers Compennssat'ion`Ihsumnee carrier and Policy number arc: 306 — HOLDOWNS
safn'er. Policy No�..J CL��r�7II�IIS
CERTIFICATE OFE):EMPTION WOFR4A1 RKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
lcssJ elhhsection mednot hecomplo"dif(be lermitisforone wndreddollaralgl00) 309 - EXTERIOR LATH
fir
1 alar mat in the Perform of the work for winch this 310 - INTERIOR LATH
Y per permit is issued,I shall not
employ any p=emn in any manner snazIt) utw
become subject Workers'Compensation 311 - SCRATCH COAT
Laws of California.Doc
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the labor Code,you must
zr
fithwithcomply with such provisions orthis reach shall be,deemed mvoked. 502 - FINAL PLUMBING ENERGY
Z: 0,
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
Ihereby Whichaffirm that there issued(Sec.3W7nding agency for the performancc of 504 - FINAL BUILDING ENERGY
z> theWork sName nthis p mdisie d(Se=.1897.civ.c.) 505 - FINAL ELECTRICAL
Y Q Lenderi Name
ILndcri Address
�Z 506 - GAS TEST
J 1 certify that 1 ply rood this application and stmt that the above information is
D. comcd.Iagxemcomplywith all city and counryoNinancesand sumlewsrclatingto 507 - FINAL PLUMBING
wilding construction.and hereby authorim mpxxritativm of this city to cnmr upon the
U FINkAV=NG
CAL
ryawvc-mentioned property for impaction keep hu
(We)agree to save,indemnify and hich M1ay in
City ofe aganinocd City 9 FIN
N liabilitics,judgmcn¢rose and expenses which may in any way eecrve against said City Cj,Z in consequence of the granting of this permit p
^ APP T UND D WILL COMPLY WITH ALL NON-POINT Issued by:5 WORKS Date /
SOU CE CGULA ION.
-IS-o Re-roofs
ignatu of Applicxm r Date
HAZARDOUS MATERIALS DISC OSURE Type Of ROOF
Will the applicant ser rmure building acupenlsmrc rhamile hazardous material
Ocfirxd by the Cupertino Municipal Code.Chapter 9.13,soil Ibe Health and Safety
.ElYu 35312(1)? Nu All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future buudin Deco ant use a If a roof is installed without first obtainingan inspection,I agree to remove
pP S p 4ulpmcm or Jcvicm which p
it hazardous air conmminante m fined by the Bay Area Air Quality Management all new materials for inspection.
svin?
❑Yes Nu
1 have mail the wuumbus materials requirements under Chaptcr 6.95 of the Califn.
nia Health K Safety Cads,Sceuons 25505.25533 and 25516.1 understand thin iftw wilding
does not currently no m that it is my responsibility to nouly the occupant fir the
xgaix ant wm=nm ar IuiSsu =ora C= Co. rOceupaney. Signature of Applicant Date
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owner r,uhh.doedagem Da" All roof coverings to be Class 'B" or better